双腔固定金属支架（LAMS）在胰周液体积聚治疗中的应用

Application of lumen-apposing metal stent in the treatment of pancreatic fluid collections

摘要:

胰周液体聚积（pancreatic fluid collections，PFC）是急性胰腺炎的常见并发症，通常发生在急性胰腺炎发病4周之后，其主要特征是具有成熟的囊壁。PFC包括胰腺假性囊肿（pancreatic pseudocysts，PPC）和包裹性坏死（walled-off necrosis, WON），二者的发生率分别为5% ~ 16%和1% ~ 9% 。PFC具有一定的自限性，无症状的PFC可采取保守治疗，当PFC出现腹痛、发热等临床症状或合并感染、出血等并发症时，则需要进行临床干预。20世纪90年代末，随着内镜超声（endoscopic ultrasound，EUS）的引入，标志着PFC治疗进入微创时代。EUS引导下穿刺引流PFC具有实时成像、精确定位、安全高效等显著优势，其技术成功率可达95%以上，临床成功率达到85.3%至94.6%，已经成为PFC的首选引流方式。双腔固定金属支架（Lumen-apposing metal stents，LAMS）是近年来新用于临床的EUS引流支架，因其独特的哑铃形设计和较大的管径可以显著提高引流效率，并建立稳固的内镜下坏死组织清除术（Direct endoscopic necrosectomy，DEN）通道，而被广泛应用于PFC引流。然而，LAMS置入相关的不良事件（Adverse event，AE）也有一定的发生率，其安全性和长期疗效需进一步评价，同时LAMS的长期管理策略和支架拔出时机仍待探究。本综述旨在系统总结LAMS在引流PFC中的应用现状及面临的挑战，为临床实践提供更多依据。

Abstract:

Pancreatic fluid collections (PFC), a common complication of acute pancreatitis, typically develop more than 4 weeks after the onset of the disease and are characterized by a mature encapsulating wall. PFC includes pancreatic pseudocysts (PPC) and walled-off necrosis (WON), with reported incidence rates of 5%–16% and 1%–9%, respectively. While asymptomatic PFC may resolve spontaneously and can be managed conservatively, clinical intervention is required when symptoms such as abdominal pain or fever arise, or complications like infection or hemorrhage occur. The introduction of endoscopic ultrasound (EUS) in the late 1990s marked the advent of minimally invasive approaches for PFC management. EUS-guided drainage offers real-time imaging, precise targeting, and high safety and efficacy, achieving technical success rates exceeding 95% and clinical success rates ranging from 85.3% to 94.6%. It has now become the first-line drainage modality for PFC. Lumen-apposing metal stents (LAMS), a recent advancement in EUS-guided drainage, feature a unique dumbbell-shaped design and larger diameter, significantly enhancing drainage efficiency and establishing a stable pathway for direct endoscopic necrosectomy (DEN). These advantages have led to their widespread adoption in PFC management. However, adverse events (AEs) associated with LAMS placement, such as stent migration, infection, and bleeding, remain a concern. Further evaluation of their long-term safety and efficacy is warranted, and optimal strategies for long-term stent management, including timing of removal, require additional investigation. This review systematically summarizes the current applications of LAMS in PFC drainage, highlights clinical challenges, and provides evidence-based insights to guide future practice.